A cold-response index for the assessment of Raynaud's phenomenon

Foerster, John; Kuerth, Anja; Niederstrasser, Eyline; Krautwald, E.; Pauli, Ruth; Paulat, Raik; Eweleit, Markus; Riemekasten, Gabriela; Worm, Margitta

doi:10.1016/j.jdermsci.2006.11.006

Cited by 26 publications

(16 citation statements)

References 13 publications

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“…We have previously shown that this local cooling test does not induce a systemic cutaneous vascular response (26), unlike cold water immersion, which is the most common cooling test because of its relative ease of use (11,34). Our method therefore allows study of microvascular response with limited systemic sympathetic interference.…”

Section: Discussionmentioning

confidence: 99%

Impaired transient vasodilation and increased vasoconstriction to digital local cooling in primary Raynaud's phenomenon

Roustit

Blaise

Millet

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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Raynaud's phenomenon (RP) is defined as episodic ischemia of the extremities in response to cold. Although the structure of skin capillaries is normal in primary RP, some data suggest impairment of microvascular function. We aimed at testing whether digital skin blood flow was lower in RP than in controls while cooling locally. We further evaluated the contribution of sensory nerves in the response. We recruited 21 patients with primary RP and 20 healthy volunteers matched on age and gender. After a 10-min baseline at 33°C, skin temperature was cooled at 15 or 24°C during 30 min on the forearm and the finger while monitoring perfusion with a custom-design laser Doppler flowmetry probe. Perfusion was also assessed after topical anesthesia. Blood flow was expressed as cutaneous vascular conductance (CVC). Data were subsequently expressed as area above the curve (AAC0 -30) of the percentage decrease from baseline CVC (%BL). CVC on the dorsum of the finger was lower in RP patients compared with controls at 15°C (AAC0 -30 were 106,237.2 and 69,544.3%BL·s, respectively; P ϭ 0.02) and at 24°C (AAC0 -30 were 86,915 and 57,598%BL·s, respectively; P ϭ 0.04) whereas we observed no significant difference on the finger pad and the forearm. Topical anesthesia increased CVC in patients with RP (P ϭ 0.05), whereas it did not affect reactivity in controls (P ϭ 0.86). Our study shows exaggerated skin microvascular vasoconstriction to local cooling on the dorsum of the finger in primary RP compared with controls. Part of this abnormal response in primary RP depends on sensitive nerves. microcirculation; skin blood flow FIRST DESCRIBED BY MAURICE RAYNAUD in 1862 (25), Raynaud's phenomenon (RP) is defined as episodic ischemia of the extremities in response to cold or emotional stimuli, often accompanied by pain. It presents clinically as pallor, cyanosis, and often rubor of the skin. Pallor indicates vasospasm and decreased blood flow, and cyanosis is a sign of deoxygenation of the static venous blood, while rubor implies reactive hyperemia (2). RP can be primary (i.e., idiopathic) or secondary to a connective tissue disease. The pathophysiology of primary RP is multifactorial and complex, with both vascular and neural abnormalities (7,15). Although available evidence suggests that microvascular function is impaired in primary RP, the exact mechanism of such dysfunction remains poorly understood.

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Section: Discussionmentioning

confidence: 99%

Impaired transient vasodilation and increased vasoconstriction to digital local cooling in primary Raynaud's phenomenon

Roustit

Blaise

Millet

et al. 2011

American Journal of Physiology-Heart and Circulatory Physiology

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“…26 Nevertheless, the descriptors of the functional recovery used for discriminating the various forms of RP are generally empirical or focus only on partial aspects of the global thermoregulatory process (for example: lag time, index of recovery, distal-to-proximal gradient, etc.). 7 In this paper we propose a thermoregulatory model, based on control system theory, to describe the functional differences associated with the control of the finger temperature. The cold challenge test activates specific responses of the system, which operates at both local (peripheral) and systemic (central) levels to restore the basal temperature and preserve homeostasis.…”

Section: Discussionmentioning

confidence: 99%

Finger Thermoregulatory Model Assessing Functional Impairment in Raynaud’s Phenomenon

et al. 2009

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Raynaud's Phenomenon (RP) is a paroxysmal vasospastic disorder of small arteries, pre-capillary arteries, and cutaneous arteriovenous shunts of the extremities, typically induced by cold exposure and emotional stress. RP is either primary (PRP) or secondary to systemic sclerosis. In this study we use Control System Theory to model finger thermoregulatory processes in response to a standardized cold challenge (a diagnostic test routinely performed for differential diagnosis of RP). The proposed model is based on a homeostatic negative feedback loop, characterized by five distinct parameters which describe how the control mechanisms are activated and maintained. Thermal infrared imaging data from 14 systemic sclerosis subjects (SSc), 14 PRP, and 16 healthy control subjects (HCS) were processed. HCS presented the fastest active recovery, with the highest gain. PRP presented the slowest and weakest recovery, mostly due to passive heat exchange with the environment. SSc presented an intermediate behavior, with the longest delay of response onset. The estimated model parameters elucidated the level of functional impairment expressed in the various forms of this disease.

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“…A modified version of the cited semiquantitative rating scales proposed for systemic sclerosis was used in scoring microvascular changes in our patients: in particular, a semi-quantitative scale was performed (as O=normal, I=slight, 2=mild, 3=severe) to quantify all described parameters (41). The enrolled patients were tested by cold, as reported in the international literature (45). Moreover, at TO, Tl, T2, T3 and T4, skin thickness was assessed using the modified Rodnan total skin score (MRSS) that represents the best clinical evaluation of dermal thickness and is both accurate and reliable (46).…”

Section: Methodsmentioning

confidence: 99%

Bosentan Treatment for Raynaud's Phenomenon and Skin Fibrosis in Patients with Systemic Sclerosis and Pulmonary Arterial Hypertension: An Open-Label, Observational, Retrospective Study

Giordano

Puccetti

Papakostas

et al. 2010

Int J Immunopathol Pharmacol

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Raynaud?s phenomenon (RP) and cutaneous fibrosis are the distinctive manifestations of scleroderma, in which Endothelin-1 plays a fundamental pathogenetic role. Bosentan, an Endothelin-1 receptor antagonist used for the treatment of pulmonary arterial hypertension, retards the beginning of new sclerodermic digital ulcers (DU). This open-label, observational, retrospective study verified the effect of Bosentan on RP and skin fibrosis in sclerodermic outpatients affected by pulmonary arterial hypertension without DU. Fourteen subjects (13 women, 1 man; mean age 60 ± 7.5 years; ten with limited and four with diffuse scleroderma) were observed at baseline (T0) and after four (T1), twelve (T2), twenty-four (T3) and forty-eight (T4) weeks during treatment with Bosentan. They were evaluated for daily quantity and duration of RP attacks and skin thickness (using modified Rodnan total skin score, MRSS). Videocapillaroscopic evaluation was performed at T0 and T4. Bosentan decreased significantly the number and duration of RP attacks, beginning at T2 (p<0.05). Videocapillaroscopy showed significant improvement of microcirculatory patterns at T4 (p<0.05). MRSS decreased throughout the study, reaching the statistical significance at T3 and T4 (p<0.01) in the whole cohort. The present data suggest that Bosentan is effective in stabilizing the microcirculation involvement and in improving skin fibrosis irrespective of scleroderma patterns.

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A cold-response index for the assessment of Raynaud's phenomenon

Cited by 26 publications

References 13 publications

Impaired transient vasodilation and increased vasoconstriction to digital local cooling in primary Raynaud's phenomenon

Impaired transient vasodilation and increased vasoconstriction to digital local cooling in primary Raynaud's phenomenon

Finger Thermoregulatory Model Assessing Functional Impairment in Raynaud’s Phenomenon

Bosentan Treatment for Raynaud's Phenomenon and Skin Fibrosis in Patients with Systemic Sclerosis and Pulmonary Arterial Hypertension: An Open-Label, Observational, Retrospective Study

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